Just found out. Monoamniotic? - Mothering Forums

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#1 of 10 Old 03-11-2008, 01:08 AM - Thread Starter
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So, I had an ultrasound (6 weeks) today and found that we have 2 babies in one sac who are extremely close to each other. I've got another ultrasound in 2 weeks and they're going to look really hard for a membrane, but with them so close together, it's worrisome.

The good news is that they're the same size and both have heartbeats.
I'd love to hear your stories.
Thanks in advance.

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#2 of 10 Old 03-11-2008, 01:27 AM
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I didn't find out I was having twins until almost 12 weeks. At that time they couldn't find a membrane, but I honestly never worried myself about it. I don't really understand what they were trying to tell you about the babies being "close together"; they're supposed to be at that gestation - it's not like there's tons of room

They looked and looked and looked for a membrane at 16 weeks. The tech was pretty sure she'd found it, but wanted another tech to come in and look. She let me empty my bladder while she'd gotten the other tech (I'd already been up twice to pee, was told to not empty my bladder completely ) and when the tech came back in the membrane was plain as day. My full bladder (the US requirement) was pushing Becka right up against the membrane so you couldn't see it.

And honestly, there's no point in worrying about a membrane until they're viable anyway. My mom and her twin just turned 45, and they're also monozygotic. The story goes that they were born with parts of their cord entangled. Crazier things have happened!
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#3 of 10 Old 03-11-2008, 03:25 AM
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At 6 weeks the placenta(s) are not formed yet so it's still to early to know most likely.

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#4 of 10 Old 03-11-2008, 11:32 AM
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I was told mine were possibly monoamniotic from 5.5 weeks until about 10, when they finally saw the membrane. Keep the faith
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#5 of 10 Old 03-13-2008, 01:33 AM
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It's such a small percentage of twins that actually are monoamniotic. (Less than 1% of all twins.) And it's really common for the membrane to be undetected or hard to see, initially.

I had an ultrasound at (what we learned was) 14 weeks because I had no idea of my dates. That was when we learned that we were expecting twins. They did not detect a membrane between them. At that far along, this scenario was less likely to be simply "a matter of time" or a still-forming membrane (which yours very well might be) so my doctor sent me to a tertiary center with a higher level ultrasound available. The tech at the Maternal-Fetal Medicine site saw the membrane within the first minute of that second scan. This was three days after our first ultrasound.

The perinatologist we saw after the scan said that is overwhelmingly the case with the people sent to them with "no membrane detected." They are able to see a membrane, after all. He also mentioned that if I'd had an earlier ultrasound (I don't remember now if he said 8 weeks or 12 weeks), we'd have been better able to count layers of the membranes and to know a bit more. (Probably able to have a better idea of when in the 4-8 days after fertilization the egg had split, because the membrane is supposed to be thinner the later it split.)

It seems possible that the placenta factor MamaRabbit mentioned could weigh in, as well. (I don't actually know when the placenta forms, but I think six weeks along is 4 gestational weeks so it's pretty early in the whole process.)

Actually, I thought that monochorionic/diamniotic twins occur when the egg splits 4-8 days after fertilization, and monochorionic/monoamniotic twins occur when the egg splits 8-12 days after fertilization. (With conjoined or "siamese" twins occuring when the egg splits later than that.) And the degree of "sharing" in each scenario is determined by how far along the process had gotten before the split occured.

In that case, splitting earlier than 4 days after fertilization yields a di/di pair because the placenta & the amnion both begin forming AFTER that period of time. So both babies will end up with their own outer and inner sacs. Splitting 4-8 days after fertilization means the placenta/chorionic membrane have begun forming before the split (so there is just one and it will be shared by the twins) but the amnion has not begun forming, so they each will have their own amniotic sacs which means they'll be separated by an amniotic membrane.

In that case, I'd think it's the amniotic membrane that would be later to form but the placenta and chorionic membrane would exist already, or at least be forming. I don't know how long it takes for that to happen, but I'm sure that the possibility of counting membrane layers at 8 or 12 weeks means that you are very likely to find something more visible at your next ultrasound, even if it's on the same ultrasound equipment as your 6 week scan. (At 14 weeks, they decided to send me to a different facility, perhaps because it wasn't a matter of whether it had formed yet, it was whether it existed but was not detectable on the machine at the smaller hospital. Which was the case.) I haven't had a second u/s at the original facility, yet. It will be interesting to see if the membrane shows up now (I'm 20 weeks along.) In that case, I guess it would have been a matter of time, rather than just better equipment.

Here is a quote from the letter of introduction at monoamniotic.org:

Like you, all of us were scared and alarmed by the diagnosis. I would like to offer you some very encouraging news. From our group's experience, more than 40% of the couples who find this support group, find they were misdiagnosed! New technology has resulted in earlier and earlier diagnosis of twins. With identical twins, an amniotic (separating) membrane is very thin and extremely difficult to find. Some couples have found a separating membrane as late as 24 weeks! Our message, keep the faith, especially if your diagnosis is early in your pregnancy.
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#6 of 10 Old 03-13-2008, 04:40 AM
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Well, this is a rather rough welcome to the world of doctors engaging in all out CYA behavior that you're probably going to get a LOT of as a mom of multiples.

First, it's very unlikely that a membrane can be detected with a regular u/s at this stage. There is a reason why most offices wait to do a level 2 until around 12ish weeks. That's given structures and babies enough time to grow a little and show up a little more. If someone is going to "diagnose" you with this at 6 weeks with a regular ultrasound, to be honest (and very blunt) I would probably have doubts about their competance. Scratch the aforementioned comment if you're already being seen by a perinatologist and/or for some reason you had the more detailed scan at 6 weeks. At that early stage many times twins are even missed. My MZ boys shared a placenta yet were not detected until 10 weeks (even though I had a scan at 6 weeks as well, due to my previous pregancy being an ectopic one that ruptured), and my doctor said that we'd do the level 2 at 12 weeks. (as another person has mentioned, I believe part of that is the viability factor. Not that viability is improved at 12 weeks for the babies BUT there's nothing that can be done for the 1st trimester so why not wait until things are developed before taking a looksee.)

So, if you LIKE your current doctor, by all means give them another shot...but if they start heavily pushing the idea of your twins being mo/mo at this stage (as opposed to the FAR more likely di/mo) I would get a second opinion at a specialist.

Mo/Mo MZ twins can have a lot of serious complications. *However* I think your doctor is engaging in CYA type of stuff, by diagnosing that at 6 weeks. That seems a little early/premature to me. The membrane between di/mo twins is often very very difficult for anyone but a very skilled tech to see especially in early-age scans. Having spent a great deal of time in the company of u/s techs with my twin pregnancy (because of my boys' TTTS) I can tell you that most techs I know who didn't detect a membrane would have consulted with at least 1 other tech in addition to (of course) the doctor before they'd say anything about it being mo/mo. My own boys' membrane was very hard to see even at 14 weeks.

I guess what I'm saying is don't worry about it yet. Realize that most doctors are going to jump the gun and tell you the worst case scenario, out of fear for lawsuits and in the name of being medically conservative. Wait until you get your level two. Don't take any action (as a warning, you will get termination counsel if they think you have mo/mo twins, if you're not interested in terminating be sure to have the nurse write it in big letters across your chart, so you don't have to constantly deal with it if you are in a multi-doctor practice) without a 2nd opinion. Or even a third, if you're in an area with a good number of peri/specialists.

It HAS been almost 5 years since I had my twins. I'm pretty sure technology has improved somewhat since then, but I'm skeptical about the diagnosis at 6 weeks.

A mo/mo twin pregnancy will be stressful and you'll have to deal with a lot of henpecking doctors and staff. So I will keep you in my thoughts. But truly, wait until the 2nd scan and opinion before putting too much stock in things, as much as you can.
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#7 of 10 Old 03-13-2008, 09:18 PM
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Hi - I haven't posted on these boards for awhile (why? 'cause I just had twins and MY GOODNESS, you've never been busy till you've had twins!), but I have to answer your post, because my girls actually were monoamniotic.

I second the recommendation to look at monoamniotic.org, it's a great resource put together by women who've been there, and it helped me through this pregnancy. (Go look at all the gorgeous photos the moms post on there of their momo babies!)

Also, it is very likely you've been misdiagnosed. But if by chance, like me, you really are carrying momo twins, know two things 1) you can have a great outcome and 2) you'll probably have to work hard to get it. My older two kids had lovely, uncomplicated, vaginal births, so it was a shock to experience the medicalized pregnancy that was my twins' journey to the world, but it was so worth it, especially at the delivery when I saw their two cords knotted TOGETHER. It certainly would have pulled tight during a vaginal birth, after the first one came out (it wasn't just like a singleton's cord in a knot, it was much more complex). Wow. The statistics you'll read on momo twins are scary, 'cause it used to be that only about half of them (or less) made it, but know that today, with proper monitoring, they almost all make it and are just fine. And even with the very medical stuff at the beginning with the pregnancy and birth, you can still practice attachment parenting once they're here (my babies love mama milk and being carried together in a sling!).

So, it's likely you won't have to worry about it, because it IS hard to spot the membrane between mono/di twins, and misdiagnosis is common. But I just wanted to encourage you that if it turns out you do have mono/mono twins, that you can get through it with two beautiful babies at the end. I did.

'kay, got to go back to pumping milk for my two lazy nursers. (oh the fun of premies!)
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#8 of 10 Old 03-15-2008, 01:59 AM
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Just chiming in for support here . . . .it can be sooo hard to see the membrane. My boys were thought to be momo . . . . . . . and I remember those long ultrasounds holding my breath hoping to see the membrane. All was well for us and all 3 of my babies were born extremely healthy. So just another multiple mom giving you a little BTDT . . and trying to reassure you a little

TripMom . . . . . loving mom : to DS (12) and BBG (10)
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#9 of 10 Old 03-15-2008, 06:39 PM
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my twins are fraternal but i wanted to say congrats
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#10 of 10 Old 03-17-2008, 06:30 PM
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I just wanted to say that we must be due around the same time with our twins! Anyways, at 6 weeks they couldn't see a membrane for me either, and today and 9 weeks they could! So hold out hope, 6 weeks is just way too early to see it!
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